This journal is
indexed in Scopus
Year 2018 Vol. 26 No 3
D.P. MARKEVICH 1, A.V. MAROCHKOV 2
FEATURES OF ELECTROENCEPHALOGRAPHIC MONITORING IN ANESTHESIOLOGICAL SUPPORT OF NEUROSURGERICAL INTERVENTIONS IN THE HEAD
Mogilev Emergency City Hospital 1,
Mogilev Regional Hospital 2, Mogilev,
The Republic of Belarus
Objective. To determine the diagnostic importance of electroencephalographic (EEG) monitoring together with different methods of anesthesia and at different stages of the surgery during neurosurgical interventions in the head.
Methods. Perioperative EEG monitoring of 34 patients operated because of the intracranial hematomas, brain tumors, and postoperative skull defects was analyzed. The first group consisted of 16 patients with the combined anesthesia (general with conductor blockades of the peripheral nerves of the scalp part of the head), the second group – 18 patients with the general anesthesia. The groups did not differ by sex, age, body weight. General anesthesia in groups was total intravenous with the mechanical ventilation with fentanyl and propofol. Blockade of nerves was performed with 0.5% bupivacaine or 0.75-1.0% ropivacaine. Cerebral state monitor was used for electroencephalographic monitoring and the cerebral state index (CSI) was monitored.
Results. There were no significant differences between CSI groups. CSI parameters at the moment of the surgery onset were 45.7±5.9 un. in 1-st group, in the 2-nd group – 54.2±17.5 un.; at trepanation: 1-st group – 51.2±15.1 un., 2-nd group – 63.1±18.3 un.; main stage of the surgery: 1-st group – 43.0±6.3 un., 2-nd group – 44.8±8.9 un.; end of operation: 1-st group – 48.1±9.9 un., 2-nd group: – 52.1±13 un.
In 5 (31.2%) patients of the 1-st group and 8 (44.4%) of 2-st group, during the skull trepanation, CSI increased more than 60 un., which required additional deepening of anesthesia by bolus injections of fentanyl and propofol.
Conclusions. There were no significant differences in CSI between the groups with the combined and general anesthesia. Taking into account the increase in CSI by more than 60 un. in 5 (31.2%) patients in the 1-st group and 8 (44.4%) of the 2-st group, preliminary additional deepening of anesthesia is necessary 3-5 minutes before the braincase trepanation.
- Zhang L, Xu L, Zhu J, Gao Y, Luo Z, Wang H, Zhu Z, Yu Y, Shi H, Bao H. To clarify features of photoplethysmography in monitoring balanced anesthesia, compared with Cerebral State Index. Med Sci Monit. 2014 Mar 25;20:481-86. doi: 10.12659/MSM.889924
- Drummond DK, Patel PM. Anesteziologicheskoe obespechenie v neirokhirurgii. V kn: Miller R, red. Anesteziia. S-Petersburg, RF: Chelovek; 2015. p. 2197-42. (in Russ.)
- Jensen EW, Litvan H, Revuelta M, Rodriguez BE, Caminal P, Martinez P, Vereecke H, Struys MM. Cerebral state index during propofol anesthesia: a comparison with the bispectral index and the A-line ARX index. Anesthesiology. 2006 Jul;105(1):28-36. doi: 10.1097/00000542-200607000-00009
- Sinha PK, Koshy T. Monitoring devices for measuring the depth of anaesthesia – an overview. Indian J Anaesth. 2007;51(5):365-81. Available from: http://www.ijaweb.org/text.asp?2007/51/5/365/61166
- Loskota W. Intraoperative EEG monitoring. 2005 Dec;24(Is 4):176-85. doi: org/10.1053/j.sane.2005.10.007
- Lipnitskii AL, Reznikov MV, Lipnitskaia VV, Iurtsev AN, Khizhniak AV, Kustrei AV. Diagnosis of cerebral death using CSI-monitoring. Zdravookhranenie. 2013;(6):57-60. http://www.zdrav.by/pdf/2013/Zdrav6.pdf (in Russ.)
- Anderson RE, Jakobsson JG. Cerebral state monitor, a new small handheld EEG monitor for determining depth of anaesthesia: a clinical comparison with the bispectral index during day-surgery. Eur J Anaesthesiol. 2006 Mar;23(3):208-12. doi: 10.1017/S0265021505002206
- Fazel MR, Fakharian E, Akbari H, Mahdian S, Yadollahi S, Mahdian M. Agreement of cerebral state index and glasgow coma scale in brain-injured patients. Arch Trauma Res. 2014 Mar;3(1):e15892. Published online 2014 Mar 30. doi: 10.5812/atr.15892
- Etezadi F, Orandi AA, Orandi AH, Najafi A, Amirjamshidi A, Pourfakhr P, Khajavi MR, Abbassioun K. Trigeminocardiac reflex in neurosurgical practice: An observational prospective study. Surg Neurol Int. 2013 Sep 18;4:116. doi: 10.4103/2152-7806.118340. eCollection 2013
- Osborn I, Sebeo J. «Scalp block» during craniotomy: a classic technique revisited. J Neurosurg Anesthesiol. 2010 Jul;22(3):187-94. doi: 10.1097/ANA.0b013e3181d48846
- Markevich DP, Marochkov AV. Blokady perifericheskikh nervov v anesteziologicheskom obespechenii neirokhirurgicheskikh vmeshatel’stv na golove. Regionarnaia Anesteziia i Lechenie Ostroi Boli. 2017;11(4):270-78. (in Russ)
- Weber F, Kriek N, Blussé van Oud-Alblas HJ. The effects of mivacurium-induced neuromuscular block on Bispectral index and cerebral state index in children under propofol anesthesia – a prospective randomized clinical trial. Paediatr Anaesth. 2010 Aug;20(8):697-703. doi: 10.1111/j.1460-9592.2010.03327.x
212030, The Republic of Belarus,
Mogilev, Botkin Str., 2,
Mogilev Emergency City Hospital,
Anesthesiology and Intensive Care Unit.
Tel./fax: +375(222) 22-16-26,
Denis P. Markevich
Markevich Denis P., Head of Anesthesiology and Intensive Care Unit, Mogilev Emergency City Hospital, Mogilev, Republic of Belarus.
Marochkov Alexey V., MD, Professor, Anesthesiologist-Resuscitator, Mogilev Emergency City Hospital, Mogilev, Republic of Belarus.